Citizens campaigning for protection of Planned Parenthood in Ohio. Source: Wikimedia Commons.
On 22 February, the Trump administration announced the final version of their new Title X regulations. The changes to the public law are being labeled as the United States’ 'domestic gag rule' by sexual health advocates, due to the restrictions now set on what doctors can tell their patients about abortion. Outrage from American citizens has been reported since the draft changes were released, and now that the changes are final, those who currently benefit from Title X have feelings of fear and uncertainty for the future of their health.
According to Planned Parenthood, Title X was established in 1970, and since then has provided "...affordable birth control and reproductive health care to people with low incomes, who couldn’t otherwise afford health care services on their own". The law allocates funds to public health facilities that provide low-income Americans with comprehensive family planning and reproductive health care, as well as affordable birth control. The federal program is the only one of its kind in the United States, and over 4 million people rely on services supported by Title X funds annually.
The new revisions to the law bar any health care clinic that performs abortions or refers patients to abortion clinics from receiving federal funding. This includes taking direct control over what doctors can say to their patients about abortion; they are no longer allowed to provide any counselling on the matter – counselling that previously was unbiased, comprehensive, and beneficial to patients’ understanding of their medical care. This directly violates both the American constitution and basic medical ethics. The American Medical Association’s Code of Medical Ethics states that "...withholding information without the patient’s knowledge or consent is ethically unacceptable". As for the constitution, it is widely known that the first amendment prevents the United States government from making laws which restrict American citizens’ right to free speech. Given that the Title X laws will create boundaries for what doctors can and cannot tell their patients, their right to free speech (in their work place) will be effectively restricted by the government and therefore in violation of the first amendment.
The concept of a gag rule has already caused disaster on the global scale. In 2017, President Trump banned federal aid to any international organization that provided and/or discussed abortions. This was catastrophic for Family Health Options Kenya, an organization that went from regularly providing safe and effective reproductive health care for thousands of citizens to closing a devastating number of facilities and leaving many more understaffed. This downsizing ultimately left thousands of Kenyan women, including and especially those from low-income backgrounds, with severely limited access to HIV testing, screening for cervical cancer, contraceptives, and abortion counselling. Before Kenya, the Bush administration’s global gag rule led to an increase in abortions in both Latin America and sub-Saharan Africa from 2001 to 2008.
By restricting patients’ access to information, the Trump administration is putting the health of many vulnerable American citizens in danger. The large majority of American women who benefit from facilities funded by Title X come from demographics that experience obstacles regarding access to health care. According to the Guttmacher Institute, most Title X patients are disproportionately low-income, one-third are people of color, and one in ten have limited English proficiency.
Now, thousands of facilities that provide abortions are forced to choose between no longer discussing or performing the procedure or continuing to provide those services, with the latter resulting in losing significant funds, thereby compromising the quality and amount of reproductive and comprehensive health care they can provide. This means that services such as prenatal care, contraception, STI testing, and life-saving cancer screenings may be more difficult to afford for low-income Americans. What the Trump administration seemingly fails to recognize is that these services make up the vast majority of services that facilities like Planned Parenthood actually provide to patients. Restricting the amount and quality of care that sexual health facilities can provide reduces American women’s overall access to reproductive health care.
Planned Parenthood provides medical care and reproductive health services to 41 percent of patients who receive care from Title X funded services, and is the only provider of publicly funded contraceptives in 103 United States counties. The new Title X restrictions bar these recipients from any access to Planned Parenthood facilities. This attack on American women’s access to health care has been labeled un-American, unethical, and unconscionable. To deny American women access to comprehensive family planning and reproductive health services is to deny them their basic right to proper medical care. When these rules go into effect, it is speculated that the number of unplanned pregnancies, maternal deaths, and unsafe abortions in the United States will significantly increase. For the Trump administration to enact laws that will soon prove to only damage and endanger the lives of thousands of American women is truly baffling and terrifying to many.
The Trump administration will soon be facing Planned Parenthood and the American Medical Association in court. The two groups are suing to challenge the legality of the rule, along with 22 US states. Several other groups, such as the National Family Planning and Reproductive Health Association, are strongly considering joining the legal battle. Many reproductive health advocates and medical professionals are rooting a successful overturning of Title X rules for the sake of protecting the health and lives of millions of American women, and to prove that the federal government’s power does not extend past the laws set by its own constitution.
On 25 February, a federal judge issued a nationwide injunction which has temporarily blocked the Trump administration's push for Title X restrictions which would remove federal funding for over 4 million low-income women. US District Judge Bastian states that the Title X restrictions “likely violates the central purpose of Title X, which is to equalize access to comprehensive, evidence-based, and voluntary family planning." The injunction does not resolve the legal case entirely, but the injunction has been received as a victory for supporters of Title X.